Medicare Expands Part B Immunosuppressive Drug Benefit for People with Kidney Transplants

The tree (kidney) is a 3D illustration of the medical environmental concept.

As of January 1, 2023, kidney transplant recipients who meet certain criteria can qualify for lifetime Medicare coverage for immunosuppressive drugs, regardless of age. This is great news! The new benefit is called Medicare Part B Immunosuppressive Drug (Part B-ID) and has a monthly premium of $97.10 in 2023. It only covers immunosuppressive drugs and no other items or services.

In the past, people on Medicare due to kidney failure, or end stage renal disease (ESRD) were eligible for 36 months of Medicare coverage after a successful kidney transplant. This coverage was crucial in large part for the payment of the hugely expensive immunosuppressive drugs necessary to prevent rejection of the transplanted kidney and keep it functioning well. Yet, unless a person was otherwise eligible for Medicare due to age or disability, this essential coverage would end in 36 months. This loss of coverage caused people huge financial strain, costing $10,000-$17,000 a year for the medication, often leading people to ration or stop taking the medications entirely, either of which greatly increased the risk of the transplant failing and the patient returning to dialysis. Many others did not even try to get a transplant for fear of not being able to afford their immunosuppressive drugs 36 months after their transplant.

Now this has thankfully changed. Read more for details on eligibility, how to enroll and more.

Understanding New Rules Regarding Insulin Costs & Rights to Switch Plans

Bottle of insulin injection with a syringe on black table and stainless steel background.

One of the many good provisions in the Inflation Reduction Act of 2022 (IRA) is the cap on out-of-pocket costs for all insulin drugs. The IRA limits out-of-pocket costs to no more than $35 per 30-day insulin prescription under all Medicare drug prescription plans. Plans also cannot charge a deductible for insulin. This means that a 60-day supply would be no more than $70, etc. And for those enrolled in Part D’s Extra Help, they will continue to pay their lower co-pay amounts.

Starting July 1, 2023 the same $35 cap per 30-day supply will apply for insulin used in traditional insulin pumps (covered by Medicare Part B).

These are significant cost-saving changes that will have a positive impact on many. Yet, as mentioned in an earlier article, this positive change is not reflected in Medicare Plan Finder’s drug cost estimates as the law took effect too late to be updated. As a result, when people researched their insulin drugs costs on the Plan Finder during Medicare’s Open Enrollment, the old, out-of-date, most-likely higher copays that plans were going to charge for insulin drugs still appeared. And these numbers won’t change until plans submit their next annual bid cycle with their Plan Benefit Package in spring/summer of 2023 to display the information for the 2024 plan year.

Therefore, if you or someone you know realize you made a wrong plan choice based on inaccurate insulin copay costs, you can call 1-800-Medicare and ask for a Special Enrollment Period (SEP) to change plans. The opportunity to ask for a SEP runs from December 8, 2022 through December 2023. You can use this SEP one time to enroll in a new plan.

For help in understanding your insulin coverage and costs, and choosing a plan which plan best meets your needs at the lowest cost is you’re using a SEP, contact your local Health Insurance Counseling and Advocacy Program (HICAP) (or your local SHIP if you’re another state) for free and unbiased assistance.

Read more.

Free At-Home COVID-19 Tests Available Again

Coronavirus Covid-19 home testing kit with swab and test tube

Good news! As part of the Biden Administration’s winter preparedness plan, the White House announced a new limited round of free at-home COVID-19 tests for the winter. Households can now order either standard at-home tests or tests that are more accessible for people who are blind or have low vision. The more accessible tests, the Ellume COVID home tests, work with a smartphone app to provide audio step-by-step instructions for administering the test and audio test results. Shipping for both types of tests is free.Older adults and people with disabilities who need support ordering the free at-home tests can contact the Eldercare Locator (800-677-1116) or the Disability Information and Access Line (DIAL, 888-677-1199).  Staff are available to assist you from 8 AM to 9 PM ET Monday through Friday. They can help you learn more about testing options, including by connecting you to accessible instructions and helping with test administration.

Medicare coverage for at-home COVID-19 tests

In addition to the tests available at covid.gov/tests, Medicare continues to cover up to 8 over-the-counter COVID-19 tests per month, including the Ellume tests. This coverage includes people with Medicare Advantage plans. You can call 1-800-MEDICARE (1-800-633-4227) with any questions, or visit Medicare.gov for more information.

Read online.